1

Introduction
This chapter introduces the CodeMaster XL+ (HP M1722A/B)
and XL (HP M1723A/B) Defibrillator/Monitor and lists technical
specifications.

Dangerous voltages capable of causing injury or death are present

at the paddles or patient cables during normal operation. This
defibrillator is to be used and serviced only by qualified personnel.

Caution Operation of this device in the vicinity of high-powered transmitters

or electrosurgical instruments may result in interference of the ECG
display.

Note , Safe and effective use of medical instrumentation requires periodic

u’
c
rir inspection and preventive maintenance. Perform the preventive
maintenance procedures in Chapter 4, Performance Verification and
Maintenance, of this manual at the required intervals to ensure
satisfactory instrument performance.

The CodeMaster These instruments are portable defibrillator/monitors powered by

internal battery or AC power. They combine a 360-joule defibrillator,
XL+ and XL
ECG monitor, and annotating strip chart recorder in a compact,
Defibrillator/Monitor light-weight package. Instrument features include crisis-oriented
controls, fast charge, a real-time clock, interchangeable paddles, and
automatic documentation of events. The monitor includes a 5-inch
screen which displays the ECG, selected ECG source, heart rate, and
messages and alerts. A microprocessor-based system rejects noise and
artifact, and automatically stabilizes and restores baseline.
In addition, the XL+ model has adjustable heart rate alarms, patient
contact indicator (PCI), recorder event marker, complete recorder
annotation, event summary, and 3- and 5-wire patient cable ECG
capability. Transcutaneous external pacing is available as an option
or field upgrade for the XL+; another option is a la-pin ECG input
connector that is compatible with the ECG patient cable. The XL+
can interface to the HP Central Station via an analog-only high-level
ECG Out signal. Figure l-l shows the XL-l- defibrillator.

Introduction l-l
 Both models fit onto the MTRO-00336L cart. The cart features
three drawers (with a latch/lock system) for storing suction pumps
and other resuscitation equipment.

Figure 1-1. CodeMaster XL+ Defibrillator/Monitor

The defibrillators are designed for long-term reliability. The modular

design makes extensive use of VLSI and gate-array technology, The
modular approach means less downtime for the user, due to the quick
field repair times inherent in the subassembly replacement philosophy
of repair. The built-in menu-driven tests efficiently aid in identifying
faulty operation, further speeding the repair process.

MTRO-00336L Cart The MTRO-00336L Cart provides mobility for the CodeMaster
defibrillators. The cart shell and drawers are constructed of a
durable light-weight polymer material that will not corrode, rust, or
dent. Built-in hand grips and 5-inch non-marring casters (two with
brakes) provide easy maneuverability. The cart surfaces are smooth
and stain-resistant, with rounded corners. Drawers can be removed
without tools for thorough cleaning.

l-2 Introduction
Inquiries For questions or comments regarding these instruments, contact the
nearest HP Sales/Service Office or to one of HP’s Service Dispatch
Centers. Always identify the instrument by model number and serial
number in all correspondence. Hewlett-Packard sales and service
offices are listed at the end of this manual. Toll-free numbers for
Service Dispatch Centers are listed in Chapter 8, Parts List.

c The following tables list the technical specifications for the

defibrillators and the mobile cart. Specifications are the same for
both models except where pointed out as being different.

Table l-l. Physical Specifications

Parameter Snecification
Dimensions 15.75” x 12.75” x 8.0” (40.05 cm x 32.39 cm x
(1 x w x h) 20.32 cm)
defibrillator:
cart: 22” x 34” x 34.5” (55.9 cm x 86.3 cm x 87.6 cm)
Weight
defibrillator: 24 lbs. (10 kg)
(includes external paddles, battery, and recorder
paper.)
cart: 82 lbs. (37 kg’)
Chemical resistance, Withstands the following: isopropyl alcohol
cleaners: (except leadwires and patient cable), mild soap
and water, chlorine bleach and water (30 ml/l of
water).

Introduction l-3
 Caution The main battery will be damaged if stored for extended periods at a
temperature greater than 50” C.

Table 1-2. Environmental Specifications

Parameter
Temperature
operating:
storage:
Humidity
operating: 15 to 95% RH, non-condensing
storage: 15 to 95% RH, non-condensing
Pressure (altitude)
operating: To 15,000 ft. (4600 m)
storage: To 15,000 ft. (4600 m)

‘Battery must be removed below 0” C (32’ F) and above 45” C (113’

0
Table 1-3. Electrical Specifications
Parameter I Specification
Defibrillator
Output energy (delivered): 2, 3, 5, 7, 10, 20, 30, 50, 70, 100, 150, 200, 300, and 360
joules.
Waveform: Damped sinusoidal (Lown).
Charge control: Push-button on apex paddle and on front panel.
Charge time (Batt. Less than 5 seconds to 360 joules.
operation):
Armed indicators: Charge clone tone, charge done lamp on apex paddle, and
available energy indicated on display.
Paddle contact indicator 3-color LED bar graph array on STERNUM paddle
(PCI): (XL+ only) indicates quality of defibrillator paddle contact before
discharge.
Paddles: Standard paddles are anterior/anterior, adult and
pediatric. Adult electrodes (83 cm sq) slide off to expose
pediatric electrodes (21 cm sq). Paddle cord is 10 ft
(3m). Full range of internal paddles are available.
Synchronizer: “SYNC" message appears on monitor and is annotated
periodic.ally on recorder while in synchronous mode. An
audible beep sounds with each detected R- wave, while a
marker on the rnonitor and sync designator on the
recorder strip indicate the discharge point.

l-4 Introduction
 Table 1-3. Electrical Specifications (continued)
Parameter Specification
Monitor
lnputs: ECG may be viewed through paddles or patient cable.
Lead I, II, III, or PADDLES selectable. Additional leads
(avR, avF, AvL, V Leads) and PADS are available (XL+
only). Monitor and recorder indicate selected ECG
source.
Lead fault: “LEADS OFF” message and dashed baseline appear on
monitor if a lead becomes disconnected.
Common mode rejection: Leads: 2100 dB and Paddles: 290 dB measured as per
AAMI standards for cardiac monitors (EC13).
Pace pulse rejection: The pace pulse rejection algorithm of this product meets
the requirements of Section 3.1.4.1 (Pacemaker Pulse
Rejection With Over/Undershoot) of AAMI EC13 - 1983
(Cardiac Monitors, Heart Rate Meters and Alarms). This
product will not reject pace pulses as described in Section
3.1.4.2 (Pacemaker Pulse Rejection With
Over/Undershoot) of the same document.
Display size and type: 5 inch diagonal (12.7 cm) CRT for 4 seconds of ECG
data on screen; non-fade, fixed trace. Scrolling trace is
selectable.
Sweep speed: 25 mm/set nominal.
Frequency response: 0.5 to 40 Hz.
Heart rate display: Digital readout on monitor from 15 to 350 BPM.
Heart rate alarms: Three pairs of high and low heart rate alarm limits from
20 to 280 BPM. On XL+, limits are configurable.
ECG output: 1 V/mV.
Patient cable length: 10 ft.
Thermal Array Recorder
Event summary: Stores and prints 3 seconds of pre-critical event data, and
(XL+ only) 8 seconds of post-critical event data for up to 28 events.
Data is retained after unit is turned off.
Annotates: Time, date, HR, ECG mode, event marker, defibrillator
mode, and selected energy. Additionally, on XL+, actual
delivered energy, peak current, and patient impedance.
Speed: 25 mm/set.
Paper size: 50 mm by 30 m (100 ft).
Recorder mode: May be configured to automatically document events and
ECG during defibrillation episodes. The recorder can be
configured to run in either real time or with a 6 second
delay.
Frequency response: 0.5 to 40 Hz. Additionally, on XL+, 0.05-150 Hz
selectable.

Introduction l-5
 Table 1-4. Power and Battery Specifications

Parameter Specification
AC Line Power
Line frequency: 50 and 60 Hz.
Line voltage: loo-230 V AC 515%.
Batterv
Type: Rechargeable sealed lead-acid. 4 Ah, 12 V nominal.
Charge time: Approximately 2 hours to 90% of full capacity. 18
hours to 100% capacity. Repeated charging to less
than 100% will reduce useful life of battery.
Capacity: Approximately 2.5 hours of monitoring, or 50
full-energy discharges, or 1 hour of monitoring and
recording.
Indicators: Illuminated LED indicates battery is charging. “LOW
BATTERY " message appears on monitor when limited
batterv cauacitv remains.

Table 1-5. External Pacer (Optional-XL+ only)

Parameter Specification
Current pulse amplitude: 30 mA to 200 mA.
Pulse width: 20 msec.
Rate: 40 uum to 180 oum.
Modes: Demand or fixed rate.
Refractory period: 40 to 580 ppm 350 msec; >SO to 180 ppm 250 msec.

1-6 Introduction
Operation
This chapter briefly summarizes the defibrillator’s operation. This
information is intended for the service person and is not a substitute
for the information in the user manuals. Refer to one of these
manuals for more comprehensive and detailed operating instructions.
w CodeMaster XL+ User’s Guide
n CodeMaster XL User’s Guide

Controls, Indicators, All defibrillator controls and indicators are located on the main
keypanel, as shown in Figure 3-l. See Table 3-l for a description of
Display, and
keypanel functions. Other figures and tables provide information
Connectors about the visible indicators on the keypanel, and the audible
indicators.
Keys for the optional pacer (XL-l- only) are located on the right
side of the carrying handle. These keys are shown in Figure 3-3.
Figure 3-4 shows the areas of the display; the information it provides
is described in Table 3-5.
The operation of some keys ,and indicators is affected by the
configuration choices made in the setup menus. Such instances are
identified by bold text and references to setup. For more information
on configuration choices and modifying instrument setup, see Chapter
2, Installation and Configuration.

The Keypanel Figure 3-l shows the defibrillator keypanel. The controls and
indicators available on the keypanel are described on the following
pages. The keys and controls that affect defibrillator functions are all
located on the left side of the panel. The center column of keys are
for recorder functions. And, the keys on the right let you control
monitor functions.

Operation 3-1
 Defibrillator Recorder Monitor

J’ M1722-28

Figure 3-1. The Keypanel

Table 3-1. Defibrillator Keypanel Controls

A Energy Select In Defib On position, selects the energy charge level for
defibrillation, in joules. Also, switches the defibrillator between the
Monitor On state for monitoring, and the Off (Standby) state.
B Charges the defibrillator to the energy level set by the Energy
Select control. When charge level is reached, the c=] indicator
lights, arid the Charge Done tone sounds, if enabled (setup).

Administers shock when buttons labelled

n -4 on paddles are
pressed simultaneously. The Shock buttons for internal paddles or
pads are located on the paddles connector.
Changes operating mode between immediate shock mode (Defibl)
and synchronized with next R-wave shock (Sync). After shock,
unit defaults to mode selected in MODE AFTER CV (setup).

3-2 Operation
 Table 3-1. Defibrillator Keypanel Controls (continued)
DW Starts and stops the recorder printing. Printing starts
immediately. If delay mode is enabled (setup), the ECG data is
delayed G seconds. Otherwise ECG data is printed real time.
E(Mark) When the recorder is on, pressing lMark annotates the ECG by
printing the marker symbol (v) at that point, if the recorder is
printing.
If the recorder is not on, pressing m also starts the recorder (if
Record on Mark is enabled in setup).
F [-Select_) On the display, changes the ECG source to be monitored. Each
time you press [iSelect), a different ECG source is displayed as
the current selection. The power-on lead selection can be changed
in setup.
G (v ECG Size A On the display, exits Autogain mode and increases or decreases the
height of the displayed ECG.
H [-Alarm) On the display, selects one of three sets of heart rate limits. Each
time you press CHRAlarm_), a different set (a low limit and a high
limit) is displayed as the current selection. The value of each set of
limits can be changed in setup (XL+ only).
I (jj) Prints an Event Summary record.
J QRS Beeper Volume Changes the volume of the QRS beeper.

Operation 3-3
 OEFIBRILUTOR RECORDER YONITOR

Ml 722-29

Figure 3-2. Defibrillator Visible Indicators

Table 3-2. Defibrillator Visible Indicators

A C-POWER) Indicates that the unit is plugged into AC power.
B Cm- Indicates that the unit is plugged into AC power and that the
battery is being charged.
C Charge Done Indicates that the Defibrillator Energy Storage capacitor in the
unit is armed and ready to shock. The indicators in the [cl
panel key and on the Apex paddle light up.
D Isync] light Indicates that the unit is in synchronized shock mode as opposed
to defibrillator mode. Flashes off each time an R-wave is detected.
Paddle contact Indicates how well paddles contact patient. (XL+ or with optional
indicator (PCI) on paddle set for XL.)
Sternum paddle

Note ,
M’
d
c
Defibrillator visible indicators cannot be enabled or disabled in setup.

3-4 Operation
Defibrill Her Audible The defibrillator emits various tone patterns to indicate different
Indicators aspects of operation. Table 3-3 lists the tones and their functions.

Table 3-3. Defibrillator Audible Indicators

Power-on tone When the Energy Select control is turned from Off (Standby) to
Monitor On or one of the Defib On positions, the tone indicates
that the power-on cycle is normal.
Charge Done tone Sounds when instrument is charged and ready to deliver a shock.
Can be disabled in setup.
Auto Disarm tone Sounds an intermittent beep ten seconds prior to an internal
disarm (this beep cannot be disabled).
QRS Beeper Sounds when an R-wave is detected. Volume is controlled by front
panel control. Cannot be disabled in setup.
CRT Alerts tone Sounds three beeps when a message appears on the screen. Can be
disabled in setup.
HR Alarms Sounds when the heart rate is above the higher alarm limit or
below the lower alarm limit. Three sets of limits are available. The
avaiIable limits are selectable in setup (XL+ only). Alarm volume
can be set in setup.
Shutdown Warning tone Alternating pitch sounds during the 60 second period before the
unit shuts down due to low battery power. Serves as an alert to
plug the unit into AC power. Cannot be disabled in setup.
Pacer Stopped Alarm If the pacer stops for any reason than a keypress (Pads off, Pads
adaptor off, Leads off, or Pacer failure), an alarm tone will sound.
Pressing any key will stop the alarm.
General Failure Alarm Defib failure, System failure, Monitor failure. Pressing any key will
stop the alarm.

Operation 3-5
 The Pacer Keys The pacer keys and functions are available only if the pacer option
is installed (XL+ only). The keys are shown in Figure 3-3 and
described in Table 3-4.
The only pacer functions that are affected by setup choices are the
power-on values for the (‘1 and (‘output functions.
When you press [Pacer], the pacer functions turn on and PACER
STOP appears at the bottom of the display, indicating that the pacer
is on but no pulses are being output. Also displayed is the current
mode (demand or fixed) and the current rate in pulses per minute
(PPM) and output level (in mA). Pressing (Model toggles the pacer
mode between fixed and demand pacing; Ihnode] can be changed only
when pacer output is off (see PACER STOP on the display). To start
or stop pacer output, press IStart/Stoe). You can change the rate and
output values at any time by pressing the (-1 and (-Output
keys.

E
L J
M1722-30

Figure 3-3. The Pacer Keys

3-6 Operation
 Table 3-4. Pacer Controls (Option-XL+ only)

A (Pacer) Turns the pacer functions on or off. Indicator lights when pacer is

B (pia-) Adjusts the pacer rate (pulses per minute) up or down. Increments
and decrements in 10 ppm steps. The current rate is displayed as
xxPPM.

Starts and stops pacer pulse output at the rate set by m and
the amplitude set by [G). On the display, PACING or PACER
STOP is displayed.

CModeJ Changes pacer mode between fixed and demand pacing. Mode can
be changed only when pacer output is off (PACER STOP on the
display). Press CStart/StopJ to turn pacer output off.
Adjusts current level (mA) of pacing pulses up or down; the
current level is shown on the display as xxmA. Increments in 10 mA
steps from 30 mA to 100 mA, 20 mA steps from 100 mA to 200
mA.and decrements in 5 mA steps.

The Monitor Display This section describes the information areas of the display,
and explains the effects of setup choices. Figure 3-4 shows the
information areas on the display; screen information is described in
Table 3-5.

L M1722-31

Figure 3-4. Display Information

Operation 3-7
 Table 3-5. Information Areas of the Display

A ECG Size The bar along the left margin of the display indicates the size of a
1 mV signal. When you first turn on the instrument, it
automatically adjusts the size. When you press (m),
Autogain turns off; the size stays at the setting you select by
pressing (v ECG Size A ]. When you turn the instrument to Off
(Standby) and then back to Monitor On or one of the Defib On
‘settings, Autogain is enabled again.
B LEADSOFF or PADS Shows a message that indicates you are attempting to use a
OFF message function that requires leads or pads that are not connected, or are
connected and making poor contact with the patient.
C DEFIB DISARMED Indicates that the defibrillator has been disarmed. This message
message appears after an automatic disarm, after holding the Charge
button for 60 seconds, after an open paddles discharge, or after a
manual disarm (turning the Energy Select control to Monitor On
when the unit was charged). To recharge the defibrillator, press

D HR xxx Dashed lines indicate no heart rate is being measured. Numbers

indicate the average heart rate detected by the monitor.
E PADDLES, PADS, ECG source currently selected. If you pick a source that is not
LEAD I, II, III, connected to the instrument, LEADS OFF, NO PADS, or NO PADDLES
and optionally aVR, is displayed.
aVL, aVF, V
F xxx/xxx, or bell When you select a set of HR alarm limits, the limits shown on the
display are replaced by a bell symbol. If the heart rate violates a
symbol a, & > limit, a tone sounds and the limits are displayed with highlighting
over the limit that was exceedecl. You can press (wAlarm_J to
silence the ton& then, the bell has a diagonal bar through it to
show that the limits are no longer being checked. Select the limits
again to have the instrument check the heart rate against the
limits.
G Trace A dashed line indicates that the instrument is not receiving a
patient ECG. When an ECG is received, either a scroll- or
sweep-type trace is displayed. The trace type is selectable in setup
H SYNC SYNC is displayed when the instrument is in synchronized shock
mode as opposed to defibrillator mode. Flashes off each time an
R-wave is detected. m key changes the mode.
[ XXXJ Shows the current charge energy level in joules. Level is selected
by the Energy Select control.
3 PACER STOP or Displayed when pacer function is turned on. (Option, XL+ only.)
PACING
K xxxx MODE When pacer is on, shows current pacer mode: demand or fixed.
(Option, XL+ only.)
L xxPPM When pacer is on, shows current (Rate3 setting. (Option, XL+
only.)
M xxmA When pacer is on, shows current pulse level set by (Output].
(Option, XL+ only.)

3-8 Operation
Connectors The defibrillator includes three connectors, in addition to the AC
power plug connector. The three connections are the defibrillator
connector, the ECG Input connector, and the ECG Output
connector. Paddles/pads sets attach to the defibrillator connector;
leads attach to the ECG Input connector. The high-level analog
signal at the ECG Output connector can be connected to an external
monitor using a 1OOO:l voltage divider cable. Compatible external
monitoring divider cables are listed in Table 3-6.

Table 3-6. External Monitoring Cables

1OOO:l voltage HP Part No.

Divider Cable
Connector Type
Six Pin M1782A
Eight Pin M 14482A
Twelve Pin M 1783A

Six-pin divider cable: p/n M1782A, eight-pin divider cable: p/n

M1783A, twelve-pin divider cable: p/n 14482A. The ECG output
is also compatible with the interface to the 14482A/B HP Central
Station analog input.

Note .I The ECG Output connector should not be used to synchronize

. another defibrillator (the ECG In-to-ECG Out delay is 35
!?
milliseconds).

All three connectors are located on the front part of the defibrillator.
For information on using these connectors, see Chapter 2, Installation
and Configuration.

Operation 3-9
Safety The following safety considerations are designed to protect the user
and patient during operation of the defibrillator and pacer. Other
Considerations safety information is located in appropriate parts of this manual.
The defibrillator stores high voltage energy and is capable of
delivering up to 360 joules of power to a 50 ohm impedance.
n Turning the Energy Select control to the Off (Standby) position
does not remove power from the instrument. Disconnecting the
unit from an AC outlet does not remove power because the battery
powers the instrument when AC power is unavailable.
n There are three methods to disarm a charged (armed) instrument:
q Turn the Energy Select control from the energy level setting to
the Monitor On or Off (Standby) position.
q Place the paddles in their holders on the defibrillator, and
depress both Shock buttons.
q The instrument automatically disarms when it has been left
charged for 60 seconds.

Caution n Do not leave the instrument turned on when it is not in use and it
4l is not plugged into AC power.
m Do not discharge the defibrillator with the paddles shorted
together. To do so can cause burning and pitting of the metal
paddle contacts.
n Disconnect any other medical electronic equipment from
the patient during defibrillation discharge unless labelled as
--
defibrillator-protected ({Ml) ({Mb).

3-10 Operation
 Warning 1 n Avoid open paddle discharges. Dangerous high voltages exist on
u the paddles when the defibrillator is discharged. Contact with this
high voltage could cause death or serious injury.
Avoid touching any metal surfaces on the instrument during shock.
Avoid connecting the patient to several devices at once, because
leakage current limits can-be exceeded.
Never’touch the bed, the patient, or any equipment connected to the
patient during defibrillation.
Keep the defibrillator and the immediate area clean and dry at all
times to avoid creating potentially dangerous electrical paths.
Do not open the instrument case. Dangerous high voltages will
be exposed. Only qualified service personnel can service the
instrument.
n Do not use the defibrillator in a flammable or oxygen-rich
atmosphere. This will cause an explosion hazard.
8 Do not rely entirely on heart rate alarms. Rate meters on pacemaker
patients can continue to count the pacemaker rates during cardiac
arrest or some arrhythmias. Keep pacemaker patients under close
observation.

AC and DC (Battery) The defibrillator operates on AC line power, on internal battery

power, or on both. The follow list provides instructions for AC
Operation
operation.
When the (jj) indicator is on, the battery is recharging.
The battery recharges while the instrument is connected to AC
power, even if the Energy Select control is in the Off (Standby)
position.
A fully depleted battery recharges to 90% of full capacity in two
hours, and to 100% capacity in 18 hours. To preserve battery
integrity, the battery must be fully recharged each time the battery
is depleted.
A new battery, or one that has been stored for an extended period,
requires 24 hours of charging before use.
While the defibrillator is not in use, connect it to AC power, with
the Energy Select control in the Off (Standby) position. This
maintains a full battery charge and prolongs battery life.
To operate on internal battery power only, disconnect the power
cord from the AC outlet.

Operation 3-11
 n A fully charged battery nominally provides fifty 360 joule
charge-shock cycles, or approximately 2.5 hours of continuous
monitoring (15°C to 40°C).

Note Continuous recording reduces the available monitoring time when you
:’ are using the unit on battery power.
v

Caution When the LOW BATTERY message is displayed on the monitor, plug
the unit into AC power. When the LOW BATTERY message is first
displayed, there is typically enough reserve battery capacity to
provide either 30 minutes of monitoring or five 360 joule charge-shock
cycles before the battery fully discharges and the instrument shuts
down. When the battery charge is almost depleted, a continuous
audible alarm begins sounding. The alarm continues for 60 seconds;
then, the instrument automatically shuts down. Plugging the unit
into AC power stops the warning and the shutdown; full operation is
immediately restored.
Frequent battery discharges to the low battery level degrades battery
life.

Properly dispose of or recycle depleted batteries according to local

regulations. Do not disassemble, puncture, or incinerate the disposed
batteries.

Operating Modes The instrument operates as a defibrillator, monitor, or pacer

(option), and it has a setup/diagnostic mode.
Each operating mode is described in the following text. For
information on the setup/diagnostic mode and using the setup
menus to configure the instrument, see Chapter 2, Installation and
Configuration.

3-12 Operation
Defibrillator
Operation
Dangerous voltages capable of causing injury or death are present at
the paddles or patient cables.

There are three basic steps to operating the defibrillator:

1. Select a. Turn the Energy Select control to the desired energy

Energy level; the defibrillator is now on.
b. Prepare and apply paddles; position paddles on
patient and apply correct pressure. See user’s guide
for detailed information.
2. Charge a. Press the Charge button on the defibrillator keypanel
or on the right (Apex) paddle.
b. Wait for the Charge Done indicators (Charge
indicator lights; also, Charge Done tone sounds, if
enabled (setup)). When the unit is armed, the
monitor display shows the available energy in joules.
If the defibrillator does not arm:
Check that the paddles connector is seated and
latched.
Verify that the Energy Select control is set properly.
To increase or decrease the selected energy level after
pressing the (Charge_) key, perform these steps:
Move the Energy Select control to the new energy
level.
Wait for the Charge Done indication, as described
above.

Keep hands clear of the paddle electrode edges. Use your thumbs to
depress the Shock buttons on the paddle handles.

3. Shock Press and briefly hold both Shock buttons (one on each
paddle) simultaneously, to deliver energy to the paddles.
a. If the defibrillator does not shock, make sure the unit
is not in synchronized shock mode; the Isvnc_l light is
on while the unit is in synchronized shock mode, and
SYNC is displayed on the screen. In synchronized
mode, the unit will only shock when it detects the
next R-wave. In defibrillator mode, the unit shocks
when it is armed and you press the Shock buttons.
Press m to change between synchronized mode
and defibrillator mode.

Operation 3-13
 Note To disarm the charged defibrillator, turn the Energy Select control to
:’ Monitor On. Any stored energy is discharged internally; the available
!?
energy shown on the display decrements; when discharge is complete,
the displayed available energy becomes blank, and DEFIB DISARMED
appears on the display.

When you are finished using the defibrillator, turn the Energy Select
control to Off (Standby).

Delivered Energy
and Shock Button
Functional Test
The following procedure provides a quick functional test of the
defibrillator and paddles.
1. Turn the Energy Select control to the 100 joules position.
2. Verify that the adult paddle electrodes are installed.
3. Push the paddles completely into their holders and press either
Charge button on the front panel or on the paddle. Wait for the
Charge Done inclicators.

Keep hands clear of the paddle electrode edges. Use your thumbs to
press the shock buttons on the paddle handles

4. With the paddles still in their holders on the defibrillator, grasp

the paddle handles and press the Apex paddle Shock button.
Verify that the defibrillator does not discharge.
5. Release the Apex paddle shock button and, then press the
Sternum paddle Shock button. Verify that the defibrillator does
not discharge.
6. Press Sync to place the defibrillator in sync mode.
7. Press and hold both Shock buttons. Verify that the defibrillator
does not discharge.
8. Press Sync again to remove the defibrillator from sync mode.
9. With the paddles securely in their holders, press and briefly hold
both shock buttons at once. A brief recorder run prints the test
results.
Refer to the user’s guide for information on using the external
adhesive pads that are available for the defibrillator.

3-14 Operation
Monitoring The defibrillator can be used for cardiac monitoring (short-term
or long-term), elective cardioversion, and pacing (optional). A
fully-charged battery provides a minimum of 2.5 hours of continuous
monitoring. For unlimited periods of monitoring, connect the unit to
AC power.
See the user’s guide for information about the different leads that can
be used for cardiac monitoring, and which ECG source to select. To
monitor a patient’s ECG with the defibrillator, follow these steps:
1. Prepare the patient.
2. Turn the Energy Select control to the Monitor On position.
3. Press (Lead) to select the ECG source. The selected source
appears in the upper-right corner of the display.

Note If the message LEADS OFF or PADS OFF appears on the display, check
the electrodes, patient cable, leadwires, and associated connections.
If the selected ECG source is not connected, a dashed line replaces
the normal ECG trace on the display.

4. Check that the ECG size has automatically adjusted to the

optimal size. To reduce the ECG size, press [YKYK’). The
“gain bar” along the left side of the display represents 1 mV of
signal amplitude.

Note Autogain automatically adjusts ECG size when the instrument is

turned on. To temporarily disengage Autogain, press (_v ECG Sire A );
now, you must adjust the ECG size manually. To reinstate Autogain,
turn the instrument to Off (Standby) and then back to Monitor On.

5. Adjust the QRS beeper volume to the desired volume.

6. For heart rate alarms, three sets of limits are available (their
values are configurable in setup-XL+ only). To choose a set of
limits, press (HRAlarm) until the desired limits are displayed. The
limits become active and are replaced by a bell symbol a).

Operation 3-15
 If the heart rate exceeds the HR alarm limits, the HR alarm limits
replace the bell symbol on the display, and the violated limit is
highlighted. Pressing [Alarm) at this point turns off the HR
alarms.
If the HR Alarms are active (bell symbol is displayed) and you
wish to review the limits, press [-Alarm_) until the desired pair of
limits is displayed. (Pressing (Hr) repeatedly cycles through
the three pairs of HR alarm limits.)

Note I HR alarms are automatically turned off when you press (cl.
.
w

7. If the HR Alarms are disabled, a no bell symbol a\) replaces the

limits on the display.

Event Summary Record During use, the unit stores up to 28 strips of critical ECG
(XL+ only) information, called events. Events include all shocks, heart rate
alarms, and mark events. Each event record includes date of event,
heart rate, ECG source, and size setting, as listed in Table 3-7. The
time annotated on the ECG strip is within 8 seconds of the recorded
event. The message “ES” is printed at the top of the ECG strip
when you print the Event Summary record.

Table 3-7. Event Summary Record Information

Event Event. Smrunary Description
Shock Shock number (delivered energy, peak current, and patient
impedance) or select&d energy, depends on setup.
Heart Rate Alarms Heart Rate Alarm limits.
violation
IMark) Marker symbol (v) annotates strip at point lMark was pressed. I

n To print the Event Summary on the recorder, press (=I. The

recorder must not already be printing when you press (Kj.

Note ,I The Event Summary requires ten seconds after the last event
. occurrence to complete the event storage. Do not turn the
U
defibrillator off immediately after a shock, HR alarm, or mark, or the
event will not be stored.

B To stop the Event Summary record printout, press (Review) or

(Record).

n To review the Event Summary at a later time, turn the unit back
on and press fjj).

3-16 Operation
 Note The Event Summary record is cleared only when the defibrillator
:’ is turned on and a new event occurs. This allows you to turn the
v
defibrillator off, and return later to review the code statistics prior to
using the instrument again.
Turn the defibrillator off between uses to ensure that the Event
Summary is reset with the new event occurance. This ensures that
event records are only for the current patient.

Recording To print a record of the current ECG and the monitor status, press’
@Z).
1 The upper line of the ECG strip contains a periodic report of
monitor parameters (Date, Time, Heart Rate, ECG Source, ECG
Size, and Recorder mode).
H The lower line of the strip records asynchronous events, such as
Shock delivery or Heart Rate Alarm violations.
n Several graphic symbols are used to annotate events, such as
Shock, HR Alarms, Mark, or Sync.
The recorder can be configured for either monitor or diagnostic ECG
bandwidth data. Delayed (6 seconds) or non-delayed operation is
also configurable. See Chapter 2, Installation and Configuration, for
detailed information.

Automatic Recordings
You can enable or disable any of the following automatic recordings:
n Record on Mark
n Record on Charge
w Record on Shock
w Record on Alarms
The automatic recordings for both delayed and non-delayed recorder
modes of operation are,defined in Table 3-8.

Table 3-8. Automatic Recordings

Event Delayed Mode Delayed Mode Non-delayed Mode
Pre-event Time Post- eventTime Post-event Time
IMark) pressed 6 seconds 3 seconds 3 seconds
CCharge_) pressed 6 seconds Until Shock or Disarm Until Shock or Disarm
event event
Shocking the patient 6 seconds 12 seconds 12 seconds.
HR Alarms violation 6 seconds 6 seconds 6 seconds
Disarm 6 seconds 3 seconds 3 seconds
Test discharge N/A 3 seconds 3 seconds

Operation 3-17
 Post Shock Data
You can enable or disable the recording of post-shock statistics using
the setup menus.
If Post Shock Data is enabled, the defibrillator records the shock
delivery statistics (actual delivered energy, patient impedance, and
peak current).
If Post Shock Data is disabled, the recorder records the energy level
to which it charged (in place of the delivered energy). For example,
if the unit was charged to 200 J, the delivered energy annotation
on the ECG strip would be 2005.

Recorder Errors
The message CHECK RECORDER appears if an error occurs while
recording. If this message appears, check the recorder paper supply.
The message may also appear if the recorder door is open.

Synchronized When the patient is already connected to bedside monitoring

Cardioversion equipment, there is a cable which plugs into the ECG output jack of
the bedside monitor and connects to the defibrillator for monitoring.
To perform synchronized cardioversion, follow these steps:
1. Plug the input end of the cable from the monitoring equipment
into the ECG input plug on the defibrillator.

Warning m When possible, we recommend that synchronized cardioversion

u procedures are performed while directly monitoring the patient through
the defibrillator pads or leads inputs. If an external monitor is used as
the ECG source, the monitor and CodeMaster XL or XL+ combination
should deliver a synchronized shock within 60 ms of the R-wave peak.
This performance cannot be guaranteed with all commercially available
monitors. To check performance with an external monitor, see Chapter
4, Performance Verification and Maintenance, for detailed information.

2. Turn the Energy Select control to Monitor On.

3. Select the desired ECG lead by pressing [Lead].
4. Press (Sync) once to place the instrument in synchronized
cardioversion mode. The message SYNC appears on the display.

Note , If the paddles are selected as the ECG source, the message USE LEADS
w’
c
d appears on the display. Although the instrument allows synchronized
shock in paddles ECG mode, leads mode is recommended. Artifact
induced by moving the paddles may resemble an R- wave and trigger
defibrillator shock.

3-18 Operation
 5. Cardioversion can be performed with the instrument in Autogain
mode. Inspect the displayed ECG before delivering the shock,
and verify that an R-wave marker (indicating shock point)
appears only with each R-wave. If a marker dot does not appear,
or if a marker dot is viewed on the T-wave segment of the ECG,
follow these instructions:
n Adjust the ECG size by pressing I-) until the marker
dot appears only with each R-wave.
n Select a different lead or adjust the electrode placement, if
necessary, to improve ECG R-wave quality.
6. Select the desired energy level with the Energy Select control.
7. Prepare the paddles, apply paddles to patient, and adjust paddles
contact. See user’s guide for detailed information.
8. Press the [Charge] button on either the right (Apex) paddle or on
the instrument keypanel. Wait for the Charge Done indicators,
and for the display to read the desired energy level.
9. Press and hold both Shock buttons (one on each paddle) until
shock occurs. The .defibrillator will shock with the next detected
R-wave.
10. If additional shocks are required, readjust the Energy Select
control as necessary, and repeat the synchronized cardioversion
procedure.

After synchronized cardioversion, the unit will either remain in the

Note
d synchronized shock mode or it will return to the defibriltator mode
after shock. The mode depends on the MODE AFTER CV selection in
setup. See Chapter 2, Installation and Configuration, for detailed
information.

After using the defibrillator, turn the Energy Select control to Off
(Standby); plug the power cord into an AC power outlet and verify
that both the [BATT) and [AC] indicators are lit.

Operation 3-19
Pacing (XL+ Only) The XL+ defibrillator with pacer option can perform external
transcutaneous pacing. The pacing option provides demand
(synchronous) and fixed (asynchronous) pacing modes. The patient is
connected to the pacer by multifunction adhesive pads for external
use; the patient can be paced and defibrillated through the same set
of pads.

To prevent receiving an electrical shock, do not touch the gelled area

of the pacing pads or the patient.
Use only HP-recommended multifunction pads with the external pacer
option. The instrument delivers pacer pulses through a low-impedance
multifunction pad. The instrument will not pace effectively with
high-impedance, pace-only electrodes.
Do not use multifunction pads for more that eight hours of continuous
pacing.

The instrument will pace on battery power alone. However, when

possible, plug the unit into AC power while pacing.
To use the pacer, follow these steps:
1. Apply pads; see the CodeMaster User’s Guide for detailed
information.
2. Attach the patient cable to the instrument’s ECG Input
connector.
3. Attach the patient cable leads to the monitoring electrodes:
4. Attach the pads interface cable (M1750A/B) to the defibrillator
output connector. Pull the latch connector toward the front of
the defibrillator to lock the connector in place.
5. Attach the pads to the pads interface cable and turn the twist
lock.
6. Turn the Energy Select control to the Monitor On position.
n If the message NO PADDLES appears, check that the pads
interface cable connector is properly seated and latched.
H If the message PADS OFF appears, check the pads connection to
the patient and to the pads interface cable.
7. Press [a) to turn the pacer on. Pacer parameters will now
be displayed at the bottom of the display:
w PACER STOP
n DEMAND MODE
n 70 PPM 30 MA

3-20 Operation
 The rate (ppm) and output (mA) settings that are displayed
when the pacer is turned on are the values selected in setup.
To change these initial values, see Chapter 2, Installation and
Configuration. The original rate and output settings from the
factory are 70 ppm and 30 mA.
The pacer is always in demand mode when it is initially turned
on. You can change the mode by pressing m only while the
pacer output is off (PACER STOP is shown on the display). If the
message PACING is displayed, press (Start/Stop] to turn the pacer
output off. You can then change the mode.

,I
Note
u At this point, no pacer pulses are being delivered to the patient. The
pacer must be started by pressing CStart/Stop), before pacer pulses are
delivered at the selected rate and output.

8. Press (Lead] to select the best Lead for monitoring while

pacing. You can only select Leads as the ECG source when the
pacer is on.
n If the message LEADS OFF is displayed, check all patient cable
connections. The pacer will not operate in demand mode if the
leads are off.
9. Press (ZZi) to adjust the pulse rate. The selected rate (ppm)
is displayed on the monitor.
10. Press Irvlode) to select the pacing mode (demand mode or fixed
mode). The selected mode is displayed on the monitor.
n In demand mode, the pacer delivers pacer pulses only when the
patient’s heart rate is lower than the selected pacer rate.
w In fixed mode, the pacer delivers pacer pulses at the selected
pacer rate.

Warning Use demand pacing mode whenever possible. Use fixed pacing mode
(asynchronous) when reliable monitoring of the patient is impractical.
For example, use fixed mode when there is motion artifact or other
ECG noise that makes R-wave detection unreliable. (You can change
the mode only when the pacer is stopped.)

11. Press (Start/Stop) to start pacing. The monitor displays the

message PACING, and displays the selected mode, rate, and
output level.
The pacer will not start pacing if there is a problem with
either the pacing pad connections or the monitoring electrode
connections in demand mode.
If there is a problem with the pacing pad connection, the
message ATTACH PADS is displayed briefly when you press
(Start/Stop).

Operation 3-21
 12. Verify that the pacer pulses are well-positioned in the diastole.
Changing leads can help to determine capture.
13. To achieve capture, increase output (mA) by pressing (Output]
until the beat is captured.
14. To set the lowest possible output level to capture, decrease the
current by decrements .of 5 mA by pressing (Output).

Note ,I If the monitoring ECG lead falls off while pacing in demand mode,
. the pacer stops delivering pulses and the messages PACER STOP and
!?
LEADS OFF appear. A continous alarm sounds; pressing any key will
silence the alarm. To resume pacing, re-attach the lead and press
(Start/Stop).
Pacing in fixed mode does not require leads to be attached for the
pacer to deliver pulses.
If a pacing pad comes off during pacing, the pacer stops delivering
pulses and the messages PACER STOP and PADS OFF appear. A
continous alarm sounds; pressing any key will silence the alarm. To
resume pacing, re-attach the pad and press CStart/Stop).

HR meters and HR alarms function during pacing, but they can be

unreliable. The HR meter attempts to count QRS activity in both
demand and fixed pacing modes. Observe the patient closely while
pacing. Do not rely on HR alarms or the indicated heart rate as a
measure of the patient’s health.

The patient can be defibrillated during pacing; see the user’s guide
for detailed instructions.

3-22 Operation